UCLA Public Health Magazine - Summer 1981 by UCLA Fielding School of Public Health

Summerl981 Magazine of the UCLA School of Public Health and the UCLA School of Public Health Alumni Association

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Publie Heal~h

Changing ti1nes

UCl.A

Publie Heal~h Summer 1981

The coming decades will be a time of challenge and exciting opportunities for public health. Although we have made great strides in the past many serious problems still need to be addressed. Mortality from the major chronic diseases has increased by more than 250 percent. Accidents are now the leading cause of death for individuals under 34 years of age. Many Americans do not have access to adequate health care. Health care costs have increased from 5.3 to 9 percent of the gross national product in the last twenty years. The quality of our environment is being increasingly threatened by toxic wastes. The need for a greater emphasis on public health and preventive medicine has been recognized by the highest levels of government. The new Secretary of Health and Human Services, Richard Schweiker, has pledged himself to support "cost effective preventive health care strategies." He states: "A goal I have set for myself ... is to put preventive health care at the top of the department's health agenda." The challenge of advancing public health in this time of fiscal restraint must be m et . The nation's schools of public h ealth are in a position to provide the leadership, the moving spirit, and the commitment for the development strate innovation and creativity in improving the distribution and quality of health care, containing health care costs, producing relevant research and implementing new information into meaningful community programs. Knowledge generated by investigators in schools of public health has identified many risk factors which are amenable to intervention and has, thus, helped us to plan the strategies which w e can use in the future. The schools of public health have also been leaders in research concerned with the quality, distribution and delivery of health care. Information from these studies has already had, and will continue to have a major impact on the manner in which health care is provided to the people in California, the United States, and abroad. I am pleased and honored to accept the challenge of participating with the faculty, students, and alumni of the School in addressing the public health problems which California and the nation will face in the coming decades. I am fortunate to have had two such excellent predecessors as Dr. Lenor S. Goerke and Dr. Lester Breslow. Dr. Goerke provided the initial leadership, the moving spirit and the commitment for the development of the UCLA School of Public H ealth. Dr. Breslow brought the School to national prominence, while increasing the size and quality of the faculty and student body. These two giants of public health have laid a solid foundation for the future development of this School and certainly have made m y job easier. It is, therefore, with great enthusiasm that I will strive with the faculty, students, staff, and alumni to m aintain and develop further the quality, creative output, and professionalism of the School. I will encourage even closer lin ks between the School's adm inistration, its faculty, its students, its alumni, and with both the public and private sectors of the public health community, since it is through this kind of supportive network that we can promote most effectively the h ealth of the community.

Roger Detels, M .D ., M.S., Dean UCLA School of Public Health

4 Roger Detels: The art of being dean 6 A tribute to Lester Breslow

9 Getting to the heart of the matter 11 Reflections on Washington, D. C.

14 It all adds up to biostatistics 16 The true test 18 Ne ws 20 Alumni

21 Notes Published for alumni, faculty, staff, and friends of the UCLA School of Public Health, in coop eration with the UCLA Office of Health Services Development, James E. West Center, Los Angeles, Calif. 90024. Executive editor: Nancy Naylor Editor: Judi Reich Faculty consultants: Lawrence R. Ash

Juel M. Janis Alumni coordinator : Barbara Broide Development officer: Judith C. Angel Design: Roy T. S. Lee COVER: Vaccinating the Poor, a wood engraving (1873) by Solomon Eytinge, Jr. National Librar y of M edicine, Bethesda. INSIDE COVER: The top graduating students in each of the six divisions of the School of Public Health received outstanding achievement awards from the SPH Alumni Association at the June Reception and Awards Ceremony held June 12 at the James E. West Center. Recognized for service to the School as well as academic excellence were (from left): Deborah Bailey, Environmental and Nutritional Sciences; Dr. Paul Balson, Behavioral Science and Health Education; Tuk Kwong Lee, Health Ser vices; Julia Kantrowitz, Biostatistics; David Weinb erg, Epidemiology; and (not pictured) Pamela Erickson, Population, Family, and International Health, who was on field study in Guatemala w hen the photo was taken. Deborah Bailey also received the Bronze M edallion, the UCLA Alumni Association's award to the outstanding graduate of the School of Public Health. Photo by Turry O'Donnell.

Roger Detels: The art of being dean by Judi Reich ast October, concluding the first half of his epidemiology lecture to sophomore medical students, Professor Roger Detels suggested a coffee break before continuing. Much to his surprise, the students declined his offer. Suddenly, two of the students from the back row ran to the front of the class, pulled two bottles of champagne from a brown paper bag, and proclaimed, "Congratulations, Dean Detels!" The enthusiasm of the medical students at the appointment of the new dean of the School of Public Health is indicative of the rapport Dr. Detels has with students in public health and medicine. When asked to describe the dean, students and faculty alike use the adjectives "approachable" and "dedicated." Dr. Detels' interest in public health began during his final year of medical school when he went to Taiwan on a fellowship. "Up until that time, I had wanted to be a medical missionary. During my work there (in Taiwan) in epidemiology, it became very apparent to me that curative or complaintprovoked medicine was not the most efficient way of promoting a change in the quality of life for the majority of people. I reflected on how I could help to do this. Being a very pragmatic soul, I selected research and teaching in epidemiology and public health," he says. The "Taiwan influence" on Dr. Detels' life is still apparent. Two large Chinese paintings hang on adjoining walls in his office. Dean Detels is contemplating using bookshelf space to display other pieces of art he and his wife have collected, "although my wife insists books more suit a dean." He grins while relating this interchange, yet becomes serious when 4

he confesses that he had to stop and take stock of himself when he first assumed this position. "I had to decide whether the deanship was going to run me or I was going to run the deanship," he says. Dr. Detels feels he is winning that battle with the help of the faculty and staff. Although he regularly works at least a twelvehour day which typically begins at 6 a.m., he still finds time for the other things he holds dear-mainly, his family. He surfs with one son, Tigger; 15, and plays chamber music on his recorder with his other son, Edward, 12. He also enjoys cooking and collaborates in producing gourmet meals with his wife, Mimi, a docent at the Los Angeles County Museum. The dean tries to take some time at noon each day to swim "because if the dean of the School of Public Health doesn't promote health, who will?" he asks. After completing his fellowship in Taiwan, Dr. Detels returned to the U.S. and completed his preventive medicine residency at the University of Washington, receiving his M.S. degree in preventive medicine in 1966. He had previously earned his B.A. from Harvard University and his M.D. from New York University. From 1966-69, Dr. Detels served as a research officer for the U.S. Naval Medical Research Unit in Taiwan, and from 1969-70 as a research officer for the National Institute of Neurologic Diseases and Stroke in Bethesda, Md. Much of his early career was spent in southeast Asia and India. He joined the faculty at UCLA in 1971 as an associate professor, rising to professor and becoming head of the Division of Epidemiology in 1972. Under his guidance, the division grew from six to more than fifteen full-time faculty members. He was appointed the third dean of the School of Public Health in November, 1980, following a nationwide search for a successor to Dr. Lester Breslow. The fact that the new dean was chosen from within their ranks has pleased the faculty. They know

how he works, he is comfortable with them, and he is familiar with the School's unique needs. For his part, the dean says, "I like the excitement of working with a group of people I respect, and certainly the faculty of the UCLA School of Public Health has my respect and enthusiasm." The feeling seems to be mutual. Indeed, it is hard not to respect a man who in the past decade has established himself as a leader in epidemiologic research. He is the author or co-author of more than sixty research articles, more of which are in progress. The two projects that especially excite Dean Detels are his current studies on air pollution and multiple sclerosis. "When I first arrived in Los Angeles in 1971, it became very apparent to me as I looked out my window what needed to be studied," recalls the dean. "About that time, an opportunity came to obtain funds from the National Heart and Lung Institute to study the health effects of air pollution." He proposed a study to compare changes in lung function over time with levels of air pollution existing in four communities in Los Angeles County- Burbank, Lancaster; Long Beach, and Glendora. "Our prevalence studies (or 'snapshot pictures') of the four communities suggest that people who live in areas which are exposed to high levels of photochemical oxidants- which is the type of air pollution we have here in Los Angeles-have poorer lung function test results than people who live in areas of low levels of photochemical pollutants," he says. Dr. Detels and his collaborators are in the process of completing the re-examination of these communities to see if changes in lung function correlate with chronic exposure to pollutants. Before Dean Detels did this work, most air pollution studies had examined the acute effects of short-term exposure. "That really isn't the most important question. If you expose people to irritants and it makes

them temporarily uncomfortable, the implication is not nearly as serious as if they have a permanent impairment of their lung function," he observes. "As far as I know, our studies are among the first to suggest that irreversible damage results from long-term exposure to photochemical oxidants." For ten years Dr. Detels and his colleagues have also been studying multiple sclerosis (MS). Some of the results, both published and soonto-be-published, are fascinating: •Changing residence frequently in childhood is common among multiple sclerosis victims. •After tissue-typing more than fifty families with more than one case of MS, the researchers have concluded that there is an MS susceptibility gene. •Since everyone who has the MS susceptibility gene does not get the disease (less than five percent), there must be an environmental "trigger mechanism." •This breakthrough in identifying people who are susceptible to MS has launched a new study which compares MS patients with their genetically similar siblings who have not contracted the disease. These and other conclusions of the MS studies may provide clues for other chronic diseases, including cancer; Dean Detels suggests. "We are used to thinking of disease as caused by a single factor. For example, smallpox-now eradicated- was caused by the smallpox virus, measles by a measles virus, and so on. However, cancer and many other chronic diseases are probably caused by a number of factors working on a susceptible individual under 'fortuitous' circumstances. This is clearly what is going on in MS," says the dean. The responsibilities of the deanship are going to mean less time for research, but Dr. Detels hopes to find a comfortable balance. The dean describes himself as a "doer;" forever challenged by new endeavors. "I think of myself as an activist," he says. His philosophy in research (which carries over to all his life choices) is to 5

focus on problems that are intellectually stimulating, challenging, and meaningful. "Within that framework, I'll take whatever comes along," he says. In his recently acquired position, Dean Detels is particularly interested in expanding the opportunities for interchange with the community. He wants to increase the role of the School in serving as a resource for the community on a variety of public health issues and has already initiated several activities which involve cooperative endeavors between the School and the state and local health departments. One gets the impression when talking to this young, tall, casuallydressed administrator that he is straightforward and honest. His enthusiasm for his job is evident when he is asked to evaluate the future of his carefully chosen profession: "The time is now ripe for public health. Even though we are entering a period of fiscal restraint, I think the California Legislature and the nation are becoming more aware of the importance of public health and preventive medicine, and of the unique role which public h ealth specialists will play in promoting health in the country in the coming decades. "Part of the reason is the role which public health scientists have played in discovering that smoking, obesity, and diet are risk factors which can contribute to heart disease, cancer, and other degenerative diseases. These discoveries have provided the public health medical community with tools with which to lower the incidence of these diseases. "Further; the cost of medical care has gone out of sight. It is clear that Americans are going to have to place a greater emphasis on prevention and on healthful living. By training our students in the scientific basis of public health and the strategies of health promotion, we hope to provide the public health leaders who will meet these challenges in the coming decades." o 6

A tribute to Lester Breslo1N

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'---- -...J "' Dr. Breslow poses with his portrait by fam ed photographer Yousu f ~ Karsh from Ottawa. The portrait is displayed in the lobby of the School.

ester Breslow retired as dean of the UCLA School of Public Health in November, 1980, after serving eight years in that capacity. Under his leadership, the size of the faculty doubled and the academic program grew so that the School is recognized as one of the finest in the nation.

His accomplish:ments, however, extend far beyond the campus. Through his commitment to understanding health and disease, Dr. Breslow has contributed to improving the quality of life of people around the world. "A leisurely review of the research writings of Lester Breslow leaves one with a lingering sense of one's own insignificance," ob-

serves his successor, Dean Roger Detels. "Lester has contributed to so many aspects of public health and has brought an innovative approach to so many issues. It gives one a sense of humility to attempt to follow in his footsteps." According to Dean Detels, several themes recur throughout Dr. Breslow's writings: the service of the scientific discipline to the promotion of the public's health, the importance of life-style and health habits on the occurrence of disease, and the importance of translating preventive knowledge into action. Dr. Breslow's actions reflect his commitment to these themes. He founded the Longshoremen Study, which has provided basic information about such risk factors as weight and cigarette smoking on cardiovascular and other diseases. Techniques for preventing disease, particularly those related to health habits and life-styles, have been developed through the Alameda Human Population Laboratory, which he also founded. Dr. Breslow was among the first to recognize the importance of systematically obtaining information on the incidence of cancer and the outcome of different treatment modalities. In 1946, he founded the California Tumor Registry, the second oldest ongoing cancer registry in the United States, and the largest tumor registry in the country. Much of the known information about the occurrence and treatment of c2ncer has evolved from this registry and from other registries which have followed it. And the list of his contributions to public health goes on. Dr. Breslow was among the first to recognize the adverse effects of cigarettes and occupational factors on the incidence of lung cancer and other diseases; and among the first to identify the elderly as a group needing special recognition by public health agencies. He has stressed the impact of social factors on disease occurrence and the importance of prevention and control, including the judicious use of screening; and he has emphasized

A man of vision In delivering the first annual Lester Breslow Distinguished Lectureship, former U.S. Surgeon General Dr. Julius Richmond used Dr. Breslow's career as a benchmark for the growth of the public health field. Excerpts from the portion of that speech relating to Dr. Breslow follow: I can think of no one who has played a more central role in shaping this nation's health policies over the past 40 years than Lester Breslow. He has been clearly ahead of his time in his insistence on a sound data base from which to chart a course from his discipline of epidemiology. He has maintained this commitment through his service on our national committee on vital and health statistics for which he now serves as chairman. He has been clearly ahead of his time in his broad social vision in bringing an interdisciplinary approach to public health practice. He has been clearly ahead of his time in his managerial skill in bringing new approaches to public health problems of chronic disease, aging, long-term care, cancer epidemiology, and radiation hazards, to mention but a few of his pioneering efforts. He has been clearly ahead of his time in his efforts to bring scientific rigor to the study of health habits or lifestyles in prevention. Long before it was fashionable, he was documenting the value of living as our grandmothers advised us to-rationally, prudently, and with moderation. He has been clearly ahead of his time in his commitment to improving the health of the people of the world. His activities as a consultant to various governments of the world, his work on various World Health Organization committees, and his services as a representative of our government have all been far beyond the call of duty. He has been clearly ahead of his time in his courage in standing by his convictions at times when courage was often not honored or respected. He taught many the lesson that principles are more important than personal prerequisites and status. His stature has been all the greater as a consequence, and his many friends are richer for the example he set.

the importance of the scientific approach to optimal delivery of health care. "Lester Breslow is practically the Renaissance man," observes Dean Detels. "Not only is he known for his ability as a public health professional, he is widely recognized as an epidemiologist, a health educator, and an expert in behavioral aspects of disease causation, health service, and international health." Dr. Breslow was honored by the UCLA School of Public Health at a gala retirement dinner held at the Faculty Center March 20. Although retiring from the deanship, Dr. Breslow continues at the School as a professor and is still active with a multitude of organizations, including the National Cancer Institute. At the dinner, speakers from all over the nation paid tribute to Dr. Breslow's distinguished career and achievements. He was continuously cited for his contributions to the University, to the health of

Californians, and to public health. His wife, Devra, who is currently editor of the UCLA Cancer Bulletin and who has been an inspiration and support in her husband's work, was also honored. Included in the program distributed at the dinner was a special tribute to Dr. Breslow written by UCLA professor Milton I. Roemer, and entitled "Dr. Lester Breslow: Humanitarian -Scholar - Teacher -Administrator.'' Portions of that essay perhaps best capture the range of the dean emeritus's accomplishments: "Since completion of his medical studies and internship in 1941, Lester Breslow has devoted his life to promoting the health of people. In World War II, he served overseas as a preventive medicine officer, and in 1946 he joined the California State Department of Public Health. For fourteen years he directed the Bureau of Chronic Diseases; he was a world pioneer in this innovative type of public health activity. He advanced steadily to 7

become the California Director of Public Health in 1965, and then accepted appointment as professor in the UCLA School of Public Health and School of Medicine in 1968. "Lester Breslow combines science and practice in all his work. While a state health official, he did original research. While a professor, department chairman, and dean, he continued an active role in public health organizationslocal, state, national, and international. He is a natural leader. He has served as president of the American Public Health Association, the Association of Schools of Public Health, and the International Epidemiological Association (to name a few), and has chaired scores of special committees. "Lester's remarkable qualities have won the admiration and respect of colleagues everywhere. In 1960, his creative role in the community control of chronic diseases won the Lasker award; in 1970, h e received the Outstanding Achievement Award of his alma mater, the University of Minnesota; and

~~~~l ;usiffdi~st. k ~. Heat:h~Af~~~e;~::~c~the ssociat10ne e gw1c Âˇ~ Memorial Medal for Distinguished Service in Public Health. "In back of all the contributions and achievements of Lester Breslow there are three basic attributes. One is a profound respect for science, both natural and social. Second is a deep concern for people and especially for the needy. The third attribute follows from the first two: a determination to do everything possible, even when this means overcoming con servative opposition, to apply scientific knowledge for the benefit of all mankind." o

A child is diagnosed for h eart disease at the UCLA Medical Center. 8

Getting to the heart of the 1natter alifornia should initiate an immediate moratorium on opening any new heart surgery facilities because too many already exist, argues a recently published study by two UCLA researchers. Ors. Shan Cretin, of the School of Public Health, and Nigel K. Roberts, of the School of Medicine, suggest an eventual consolidation of existing heart centers since an over abundance may lead to higher mortality rates, increased costs, and in some cases, unnecessary surgery. Their study basically analyzes the state's twenty pediatric cardiac centers. In the process, however, the investigators were also able to collect some data pertaining to adult heart surgery facilities. The report calls for the state to implement a planning strategy to efficiently utilize cardiac care resources. According to Dr. Cretin, there are over 100 centers in California performing open heart surgery on adults and children. Many of these centers are under-utilized. Centers which perform fewer operations have a higher mortality rate than higher volume centers. "We really don't have the data to pinpoint what it is about the high volume centers that leads them to be better. .. Is it because the surgeons do more surgery? Is the quality of the team assisting the physician higher? Is the nursing care which immediately follows surgery better?" Dr. Cretin asks. "Whatever the reasons, a disproportionate number of deaths occur at low volume centers." The study documents that hospitals performing more than 200 heart surgeries a year have a lower mortality rate than hospitals that perform fewer operations. The researchers quickly add, however, that this finding does not imply

that all small centers have poor mortality records. Besides the mortality issue, service duplication can also cause inflated medical bills for patients. "If you look at the investment being made in capital equipment for open heart surgery, it far exceeds what is needed to provide the level of surgery that is now being done in the state. The hospitals set their rates to cover the costs of the equipment," Dr. Cretin explains. "The current system of paying for medical care is such that consumers may not feel the costs directly (private insurance or Medicare may cover expenses, for example) but ultimately we all pay when the insurance rates go up the following year." Along the same lines, if hospitals have made major investments in their heart surgery centers, they may perform unnecessary surgeries in order to fully utilize the facilities . Of course, it is often hard to determine what is considered "unnecessary." "But the general theme emerging in the literature is, yes, when you have excess capacity, there's a tendency to fill it up with marginal cases that might not be all that appropriate for an operation . .. so there is a possibility for generating excess surgery," Dr. Cretin says. While completing the study, Dr. Roberts, a pediatric and adult cardiologist, was asked to serve as a consultant in Sacramento on the Statewide Task Force on Cardiac Care, which is trying to establish guidelines for the planning of cardiac centers. One of those guidelines could well be "numbers"- that is, requiring that a minimum volume of cardiac surgeries be performed at a hospital in order for it to be approved as a cardiac center. "One of the things I stress to practitioners is that I don't believe that only numbers should be considered when setting up stan-

dards," Dr. Cretin says. "And it would be a serious mistake to do that because there is the possibility of just setting up a mill and churning a large number of cases through, without maintaining a high quality of care." She encourages the state to move ahead thoughtfully. Need, cost, accessibility, and mortality are four important criteria to consider when determining which centers should be allowed to remain open. She disagrees with two indiscriminate approaches to decreasing the number of cardiac centers in the state: refusing approval or licensure to the first, say, ten hospitals that need new equipment or expansion; or closing centers simply because they are small. "Further, if you are going to ask a hospital to forego something, like a program in open heart surgery, you are going to have to look at what you can give them in return," she says. Restructuring the delivery of care may be one way of compensating hospitals. Dr. Roberts has suggested setting up a " level of care system" so that certain centers could provide primary care (non-invasive tests, for example); other centers could give secondary care (certain simple operations or procedures); and a few centers in the state could administer tertiary care, handling the most complex and experimental procedures. Ors. Cretin and Roberts conducted their studies for two years without any monetary assistance. In 1979, they received the California Policy Seminar Grant, which is part of a joint program between the University of California and the state legislature to encourage important policy research. In the aftermath of the June completion of their research, widespread media attention has focused on their findings. Ors. Cretin and Roberts were asked to testify last 9

Drs. Shan Cretin (left) and Nigel Roberts collected masses of data for their study. year at the state's Joint Legislative Audit Committee's hearing on children's open heart surgery. The study, and the attention it continues to receive, is encouraging for the field of public health, explain the researchers. "Public h ealth has been trying to determine h ow to collect and analyze data in such a way as to help make those trade-offs between accessibility and costboth mortality costs and dollar costs. We think we have shown, by example, how it can be done in one area," Dr. Cretin says. "In terms of what our study can do for the public's health, I sincerely believe the public's health would be better with fewer cen ters. And I feel we, as public health 10

professionals, have a responsibility to do two things. One is to develop the information and data in these technical areas into a form that people can understand, and then to disseminate widely the information so consumers are aware of their options and can act intelligently when selecting forms of health care. "Secondly, we have to encourage hospitals to act responsibly. We can do this by working with policymakers to change incentives in the h ealth care system and to institute planning legislation that contains health costs and assures a high quality of health care services." Dr. Cretin first collaborated with Dr. Roberts in 1977 when h e asked

her to help collect data on the prevalence of children with different types of heart disease. Her field of expertise is quantitative m ethods and statistics. She has taught at the UCLA School of Public Health since 1976. She is also a consultant to the Statewide Cardiac Care Task Force. Dr. Roberts has been associate professor of medicine and pediatrics at UCLA since 1973. He has published extensively on both congenital and acquired h eart disease. o f.R. For copies of the report, Surgical Care for Cardiovascular Disease in California: Present Status and Future Policy (California Policy Seminar Monograph Number 8), write the Institute of Governmental Studies, 109 Moses Hall, University of California, Berkeley, California 94720.

ReOections on Washington, D.C. by Michael Parrish Washington, D.C., was a valuable experience, but Drs. Irvin M . Cushner and Stuart 0. Schweitzer are glad to be home. "I had a good time, learned a lot, and met some good people," says Dr. Cushner; who is these days again responsible for courses in reproductive health services, human sexuality, and women's health services in the UCLA School of Public Health. "I found it a fascinating and heady kind of experience, but I also found the processes within which I worked to have some characteristics that weren't entirely my cup of tea." Dr. Cushner served two years in the Carter Administration as deputy assistant secretary for population affairs in the Public Health Service in the Department of Health, Education and Welfare (HEW- now the Department of Health and Human Services). Dr. Cushner was the person in the federal government responsible for coordinating and monitoring family planning and population affairs on both the national and international level. On the home front, he was the federal official responsible for administering Title X of the Public Health Services Act, a law which authorizes roughly $240 million for services and research in population affairs. In addition, Dr. Cushner was the. principal liaison between HEW and other federal and world organizations on issues concerned with family planning and population affairs- the United Nations, the State Department, the World H ealth Organization, to name a few. Dr. Cushner recalls most of his work in Washington with genuine enthusiasm; as to what wasn't exactly his cup of tea, he maintains a gentlemanly silence. Perhaps Dr. Schweitzer's last day in the Carter Administration gives a hint of what those moments of

unavoidable frustration might have been like, however. Dr. Schweitzer; too, is a veteran of the bureaucratic ups and downs of the Carter Administration, having returned to teaching and research in health-care economics in the Division of Health Services after spending nine months on the senior professional staff of the Presidential Commission for a National Agenda for the Eighties. Dr. Schweitzer's concluding experience intertwined politics, news events, and plain, blind chance. The Commission's report has so far received little public attention, not only because it originated with a President soon to be on his way back to civilian life, but also because it became lost in the considerable flap over a misreading of one of the committee's recommendations. Misled by a news leak from the Carter Administration, the Washington Post published a story erroneously suggesting that the Commission had recommended federal support for a population shift to the Sun Belt. " Eighty percent of the publicity we got was directed at that," Dr. Schweitzer says today with surprisingly good humor. Also competing for news coverage with the Commission's report were the

negotiations for the release of the hostages in Iran and the inauguration of President Ronald Reagan. Neither Schweitzer nor Cushner were surprised at such experiences, however-both previously have worked in Washington, though neither has served in the federal government before. Nor did either feel that their time was ill spent. Dr. Cushner sees a significant role for academic health professionals at these highest levels of government. "This is perhaps a bias of mine," he says, "but I think that the faculty in schools of public health have the backgrounds and the skills and experience that allow them to make some significant contribution to policy development ... but when you're serving on campus as a faculty person, the only opportunity you have to influence public policy is either to write articles about it or to respond to a request for testimony." Benefits also accrue to the "sending" academic community. "There is no better crash course in how policy is made, planned, and implemented than actually

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being there and participating in those processes," says Dr. Cushner. "I think the benefit to the University is that one is then a better teacher of health policy for having been there and having learned all the nuances of that process." Dr. Cushner's teaching has taken a new slant as a result of his experiences. H e designs realistic scenarios for his classes in an attempt to expose students to the public health activism they might encounter as professionals . In his " Current Issues in Reproductive Health" course, for example, the class has held hearings in which each student testified; drafted letters to Congress on a specific issue; and acted as a mock task force for the Association of Public Health to decide what that organization's policies should be toward home births and birthing centers. "In doing this with the course, I am describing in great detail to the class where the sensitive spots are in the federal government-who the various actors are and which people are in a position to make major policy decisions," Dr. Cushner explains. Dr. Schweitzer is at least equally 12

enthusiastic about academicgovernment interchange. "For anyone involved in public policy," he says, "it's terribly important to have some experience in Washington-not just once in one's lifetime, but on a recurring basis. I'm not saying that one should move to Washington, and I'm very happy here at UCLA, but I think that all parties benefit when our faculty goes there. There's no question that our teaching programs become much more relevant, and much more exciting, when enriched by the Washington experience. Secondly, I think government is better for having outsiders come in with a somewhat fresher look; one not so institutionally grounded, one with perhaps less vested interest in existing programs . Thirdly, I think the University itself benefits enormously in terms of prestige. Dr. Cushner and I just returned from Washington, and I think the visibility of our University was enhanced by our being there. "I was delighted, by the way," adds Dr. Schweitzer; "at the extent to which UCLA is well-regarded in Washington. Many of our pro-

grams-and I think our School of Public Health paramount among them, really-are very, very well respected." Neither scholar is cheerful about the near future of public health policy in the United States. And more than the recent change of Presidents is involved. For the most part, the economy brings on their somewhat gloomy predictions. Dr. Cushner uses as an example an issue bound to be raised sooner or later: Should Medicaid pay for infertility treatments in the case of couples too indigent to pay for their own? "If there were lots of money around," he says, "there might be some philosophic questions about whether or not the federal government wants to get involved in the infertility business, right? But with the kind of fiscal conservatism that 's being projected right now, I don't think any philosophic questions are going to have any room." Dr. Cushner thinks it's too early to tell exactly what the new administration's policies are going to look like, with the exception of Reagan's rather well-known stand against federally regulated comprehensive national health insurance. However, on women's health programs, an area of great interest for him, Dr. Cushner is not entirely sanguine. "First of all, the whole concept of women's health-and by that I mean health problems that are specific to women, and also health problems that are of special significance to women -has only recently been looked at as a specific area of health that needs some emphasis and some coordination. So my guess would be that the Reagan Administration is going to look at it the way previous administrations have looked at it, and that is as a low priority-if it gets any attention at all," says Dr. Cushner who, while serving in Washington, supervised with Dr. Juel Janis (who is the new assistant dean in the UCLA School of Public Health), the preparation of a report on women's health in the U .S.

t I

This was the first comprehensive compilation of women's health issues done by the Public Health Service and was subsequently published as a speciaf supplement to Public Health Reports. Dr. Schweitzer has worries about the future, too. "There's going to be very tight, very constrained financing for educational programs in the health sector, and for research," he warns. "And to some degree, schools of public health have been tarred with the same brush that seeks to reduce the output of medical and dental schools. It's now widely acknowledged that we're beginning to generate a surplus of physicians and dentists, and so people are talking about reducing- in fact, the government has taken measures to reduce - the federal subsidy for those training programs. "What is not sometimes appreciated," Dr. Schweitzer continues, "is that a school of public health, although thought of as working hand in glove with a medical or dental school, is ir, fact a very different sort of institution . .. So I would hope that those kinds of constraints wouldn't hit us as hard as they might be hitting other schools within the health sciences. But I'm not terribly optimistic." About his recent work on the Carter commission, where he concentrated on the financing of a national h ealth insurance system, he has more reason for hope. Briefly, the Commission recommended against the sort of highly regulated national health program promoted in various forms by Sen. Edward Kennedy. Instead, it calls for a private-sector program using vouchers issued by the federal government. The vouchers would insure all citizens a basic level of health care through a private insurance company, on contract, but these vouchers could also be applied towards insurance at a higher rate- and with more attractive benefits-at other private companies. The advantage to consumers, as Dr. Schweitzer sees it, would be improved freedom of choice, since some~ne willing and

able to add $20 a month to their government vou cher might be able to add a feature, such as dental insurance, if that weren't already mandated by the governing federal regulations. Today, a person on Medicaid has a restricted number of services and physicians available- and cannot apply government benefits to better quality, or merely more appropriate health plans. The advantage to the health care system as a whole, according to the Commission, would be that this scheme applies the pressure of marketplace competition to competing private insurance companies-and, behind them, to the h ealth-care providers themselves - to keep costs down. Oddly enough, Dr. Schweitzer notes, had he intended to be politically opportunistic, he would have come up with much the same plan. For though the Commission's recommendations are now those of an out-of-power administration, several officials in the Reagan White House have endorsed similar schemes in the past and are aware of the Commission report. "And so I think the chances of

the Reagan Administration moving in the direction of a consumerchoice, rather than a regulated health insurance system are strong," says Dr. Schweitzer, "though probably not for a couple of years." Incidentally, about one aspect of himself Dr. Schweitzer, like Dr. Cushner, also keeps a gentlemanly silence. He won't tell even his own children how he voted in the last election. o Editor's Note: The Washington, D.C. scene is by no means foreign territory to other UCLA School of Public Health faculty and alumni. Many, too numerous to list, have served in the nation's capital while others continue to be involved in federal committees, programs, and other activities .

Michael Parrish has written for N ew West, Rocky Mountain Magazine, Los Angeles Times, Chicago Reader, and other publications.

It all adds up to biostatistics

Dr. Abelmonem Afifi tries to figure this one out.

by Russ Hudson The problem posed by the art history student was a unique one. He wondered if the people who carved African elephant tusks were communicating through their art. The student needed to interpret the data so he sought advice from a biostatistics consultant. Without blinking an eye, the consultant added this student to his growing list of diverse clients. Over the weeks, he had given suggestions to a biology student studying the stomach content of squirrels, to a nursing student surveying the effectiveness of breast self-examinations, to a public 14

health student analyzing nutritional data from Rwanda, and to one studying epilepsy among Hispanics. The consultant, actually a graduate student in biostatistics at UCLA, had listened intently to each of his clients. Then, setting up appointments for the following week, he promised to answer their questions after bringing the information back to class for presentation and analysis. The words "take this back to class for presentation and analysis" are key words in explaining why students in the Division of Biostatistics in the UCLA School of Public Health have an advantage

over students from many other universities. By the time a student is graduated from the UCLA program, he or she will have had numerous hours of on-the-job experience. They don't, as instructor Dr. Donald Guthrie says, "leave here with nothing to work with but textbook experience." Dr. Guthrie, with 25 years experience of his own as a statistical consultant, is one of the instructors of the course on consulting. He also helps manage the closelyrelated biostatistics consulting service. Both the course and the consulting service began two years ago. Dr. Guthrie observes that the

type of course he teaches is spreading to many of the country's biostatistics programs, although slowly. He says he was first exposed to something similar ten years ago at Oregon State University. "The purpose of our course is to orient students to interact with clients - how to conduct an interview, for example. After completing the course, they receive the practical experience of statistical consultation. Here, they actually work with clients on a weekly basis for as long, or short, a time as necessary," Dr. Guthrie explains. Biostatistic graduate students are required to sign up for the consul ting course in their second year. From then until they graduate, they help clients set up research experiments or untangle masses of data. Each Friday, students in the course gather for a presentation and analysis session with faculty and doctoral students. No solutions are offered to the client without first being approved by these supervisors. "I like to be hard on them, to attack them. They'll tell me what they did and I'll demand: 'Why did you do that? What is that supposed to accomplish?'" Dr. Guthrie says. "It makes them defend themselves, makes them think. I'm tough on them, but they want me to be." Being tough on the students is a necessary part of the training, Dr. Guthrie says, the part that makes a UCLA biostatistics graduate highly desirable in the professional ranks. " If the ccurse and the consul ting service were eliminated, students would still have theory, but they wouldn't be ready for the real world," Dr. Guthrie insists. Further, biostatistics students require "desensitizing" toward some of the projects on which they may be working. He explains: "Students have to get used to the idea of talking about things like cancer experiments. This is one area in which clients who come into class with real projects can help. We get clients from all over the University by posting signs and spreading the word around the campus."

The consulting service is only one of several programs in the ever-growing Division of Biostatistics. When the division was launched twenty-five years ago, one of the first in the nation, it had only one staff member. Now it boasts eight full-time and seven part-time faculty members who work with the assistance of doctoral and post-doctoral students. Biostatistics can be defined as statistical methodology applied to health science research, according to Dr. Potter C. Chang, who heads the division. The purpose of the division, then, is to train professionals who are capable of apply-

ing statistical and quantitative methods to the solution of problems encountered in the community health field, medicine, and life sciences; and to conduct research to improve the methodology of biostatistics. Dr. Chang points out that before analysis of statistics can take place, students must learn how to organize, store, and retrieve masses of data efficiently. "Data management, as this process is called, is really the front end of statistical data analysis," he says. "And with today's increasing research activities, more of these data management skills are necessary, so

Who's who The faculty of the Division of Biostatistics are active in a variety of research projects. A brief capsule of their current endeavors follows. Abelmonem A. Afifi, professor, has had extensive experience consulting and conducting research for international organizations. His text, Statistical Analysis: A Computer Oriented Approach, will be printed in Russian this year. Potter C. Chang, professor and head of the Division of Biostatistics since June, 1980, is interested in the application of statistical methods to medical research, particularly for the improvement of laboratory procedures. Dr. Chang has been actively involved in the development of severity indices for intensive care, and is also interested in procedures for variable selection in regression and discriminant analysis. M. Myra Chern, assistant professor, is interested in methodology development for genetic studies of heterogeneous diseases including epilepsy and diabetes, and in the evaluation of computer data management systems. Virginia A. Clark, professor, is a consultant for a variety of studies in multiple sclerosis, depression, effects of zinc supplements for pregnant women, effects of Agent Orange on veterans, outpatient care in dentistry and medicine, and childbirth experiences of Hispanic women in two Los Angeles hospitals. After receiving her Ph.D. in biostatistics from UCLA in 1963, she joined the faculty of the School of Public Health. She served as chairman of the department and associate dean of the School from 1974-1979. William G. Cumberland, assistant professor, has recently published research on finite population sampling, and stochastic modelling of population growth. Wilfrid J. Dixon, professor, is the chief of the Sta tis ti cal Research Unit at the Brentwood Veteran's Administration Medical Center. He is world renowned for his contributions to statistical methodology and was the prime mover in developing

BMD (Biomedical) Computer programs. Frederick J. Dorey, part-time lecturer, is interested in the problems associated with the selection of prognostic variables for cancer. He is a consulting statistician at the UCLA Jonsson Comprehensive Cancer Center BASE (Biostatistics Analytic Support and Epidemiology Unit) . Olive Jean Dunn, professor, is interested in statistical methodology-including mu!tiple confidence intervals, classification problems, and correlation methods. Her textbook, Basic Statistics, is widely used as an introduction to biostatistics. A second textbook, Applied Statistics, written with UCLA Professor Virginia Clark, is an analysis of variance and regression. Robert M. Elashoff, professor, is working on developing methods for the study of synergism. He is head of the UCLA Jonsson Comprehensive Cancer Center BASE Unit. Donald Guthrie, adjunct professor, current interests are in the application of statistics to the biobehavioral sciences and to statistical computing. Robert I. Jennrich, professor, is a leading national authority in factor analysis. Martin L. Lee, part-time lecturer, is interested in the application of statistical methods to radioimmunoassays. Frank J. Massey, Jr., professor, has been a statistical consultant for a variety of epidemiological and public health studies. He is currently principal investigator of a national co-operative study on the health status of American males. He is presently revising his Introduction to Statistical Analysis, a text written with Dr. Dixon and regarded as a classic text in statistics. Jean L. Mickey, lecturer, is particularly interested in mortality at the beginning of life. She is investigating possible associations between birth outcome and air pollution exposure. James J. Palmersheim, part-time lecturer, works for Los Angeles County as a medical data consultant for the Data Processing department. He teaches an introductory statistics course. 15

type of course he teaches is spreading to many of the country's biostatistics programs, although slowly. He says he was first exposed to something similar ten years ago at Oregon State University. "The purpose of our course is to orient students to interact with clients- how to conduct an interview, for example. After completing the course, they receive the practical experience of statistical consultation. Here, they actually work with clients on a weekly basis for as long, or short, a time as necessary," Dr. Guthrie explains. Biostatistic graduate students are required to sign up for the consulting course in their second year. From then until they graduate, they help clients set up research experiments or untangle masses of data. Each Friday, students in the course gather for a presentation and analysis session with faculty and doctoral students. N o solutions are offered to the client without first being approved by these supervisors. " I like to be hard on them, to attack them. They'll t ell me what they did and I'll demand: 'Why did you do that ? What is that supposed to accomplish?"' Dr. Guthrie says. "It makes them defend themselves, makes them think. I'm tough on them, but they want me to be." Being tough on the students is a necessary part of the training, Dr. Guthrie says, the part that makes a UCLA biostatistics graduate highly desirable in the professional ranks. " If the ccurse and the consulting service were eliminated, students would still have theory, but they wouldn't be ready for the real world," Dr. Guthrie insists. Further; biostatistics students require ''desensitizing'' toward some of the projects on which they may be working. He explains: "Students have to get used to the idea of talking about things like cancer experiments. This is one area in which clients who come into class with real projects can help. We get clients from all over the University by posting signs and spreading the word around the campus."

Who's who The faculty of the Division of Bios ta tis tics are active in a variety of research projects. A brief capsule of their current endeavors follows. Abelmonem A. Afifi, professor, has had extensive experience consulting and conducting research for international organizations. His text, Statistical Analysis: A Computer Oriented Approach, will be printed in Russian this year. Potter C. Chang, professor and head of the Division of Biostatistics since June, 1980, is interested in the application of statistical methods to medical research, particularly for the improvement of laboratory proce<lures. Dr. Chang has been actively involved in the development of severity indices for intensive care, and is also interested in procedures for variable selection in regression and discriminant analysis. M. Myra Chern, assistant professor, is interested in methodology development for genetic studies of heterogeneous diseases including epilepsy and diabetes, and in the evaluation of computer data management systems. Virginia A. Clark, professor, is a consultant for a variety of studies in multiple sclerosis, depression, effects of zinc supplements for pregnant women, effects of Agen t Orange on veterans, outpatient care in dentistry and medicine, and childbirth experiences of Hispanic women in two Los Angeles hospitals. After receiving her Ph.D. in biostatistics from UCLA in 1963, she joined the faculty of the Sch ool of Public H ealth. She served as chairman of the department and associate dean of the School from 1974-1979. William G. Cumberland, assistant professor, has recently published research on finite population sampling, and stoch astic modelling of population growth. Wilfrid J. Dixon, professor, is the chief of the Statistical Research Unit at the Brentwood Veteran's Administration Medical Center. H e is world renowned for his contributions to statistical m ethodology and was the prime mover in developing

BMD (Biomedical) Computer programs. Frederick J. Dorey, part-time lecturer, is interested in the problems associated with the selection of prognostic variables for cancer. He is a consulting statistician at the UCLA Jonsson Comprehensive Cancer Center BASE (Biostatistics Analytic Support and Epidemiology Unit). Olive Jean Dunn, professor, is interested in statistical m ethodology-including multiple confidence intervals, classification problems, and correlation methods. Her textbook, Basic Statistics, is widely used as an introduction to biostatistics. A second textbook, Applied Statistics, written with UCLA Professor Virginia Clark, is an analysis of variance and regression. Robert M. Elashoff, professor, is working on developing methods for the study of synergism. He is head of the UCLA Jonsson Compreh ensive Cancer Center BASE Unit. Donald Guthrie, adjunct professor, current interests are in the application of statistics to the biobehavioral sciences and to statistical computing. Robert I. Jennrich, professor, is a leading national authority in factor analysis. Martin L. Lee, part-time lecturer, is interested in the application of statistical m ethods to radioimmunoassays. Frank J. Massey, Jr., professor, has been a statistical consultant for a variety of epidemiological and public health studies. He is currently principal investigator of a national co-operative study on the health status of American males. He is presently revising his Introduction to Statistical Analysis, a text written with Dr. Dixon and regarded as a classic text in statistics. Jean L. Mickey, lecturer, is particularly interested in mortality at the beginning of life. She is investigating possible associations between birth outcome and air pollution exposure. James J. Palmersheim, part-time lecturer, works for Los Angeles County as a medical data consultant for the Data Processing department. He teaches an introductory statistics course. 15

The true test Choose the best answer: Examination, or evaluation, is : (a) a continuous process (b) based upon criteria (c) cooperatively developed with the student (d) concerned with the measurement of the learner's performance, the effectiveness of teachers, and the quality of the program (e) all of the above.

.1.\ll6111â&#x20AC;˘.., -~-...l._____..._~--~--~~~.lfjl:'iiiiiilL_ __

Discussing a computer read-out are (from left) Drs. Potter Chang, head of th e division , M. Myra Chern , and William Cumberland. this has been a new emphasis in our division." A new series of four courses on data management began in the spring quarter of 1981. The program was organized by Ors. A. A. Afifi and William Cumberland and the courses are being developed by Dr. Myra Chern. She says the courses she will offer here are unique. They will be based on her experience as a biostatistician and data management specialist on several research projects in the genetics of diabetes and epilepsy. The introductory data management course offered for the first time this spring is a "service course" designed for students in all public health areas. Three more advanced courses are being developed for those intending to specialize as health data managers. The courses have counterparts only at a few other universities. UCLA is the only institution at which an academic program in data management is designed specifically for the health field, according to Dr. Chern. The Division of Biostatistics 16

awarded its first M.S. in 1960. The first Ph.D. was granted three years later. Since then more than 250 advanced degrees have been granted-at the level of Dr.P.H., M.S., M.S.P.H., and M.P.H. Many doctoral students have also studied on a non-degree basis. The division continues to grow. Judging by one yardstick of success - employment after graduation - the program can be called enormously successful. All of the graduates have jobs. And Dr. Chang doesn't anticipate any decline of activity in the field in the near future. "Biostatistics has been steadily growing since the turn of the century when the field was recognized, through agricultural experiments, to be a separate scientific discipline. Public health research utilizing new computer techniques has made possible advances never before contemplated."

Russ Hudson is a journalist based in Torrance, Ca.

-1

If you have answered (e) on the above mock examination question, chances are you have been influenced by the teachings of JeanJacques (J.J.) Guilbert, M.D., Ph.D. Dr. Guilbert is the chief medical officer for educational planning in the division of health manpower development of the World Health Organization (WHO) in Geneva, Switzerland. He is also the man who introduced the multiple choice test to Europe in the 1960s as one way of evaluating students ' performances. For the past twenty years, he has been attempting to incorporate basic principles of learning into the teaching of health professionals. His policies stress that students should be actively involved in educational decisions. They should play an integral part in designing their educational program and in the evaluation process. Secondly, Dr. Guilbert insists that health professionals must be trained to respond to the particular needs of each community in which they work. In other words, what may apply in Los Angeles might be irrelevant in Brazzaville, Congo. "We are looking for an educational approach for health professionals that teaches them to be responsive to community health needs, and to finding solutions to existing and future health problems of the community," Dr. Guilbert says. "When setting up this type of educational program, the definition of the goals and objectives of the school should be made by the school with and for the students."

Dr. Guilbert realizes that his general precepts about education sound simple. Their implementation, however; usually requires changes in most curricula and in the ways teaching is approached. He says today's educational system depends far too much on recall (memory) rather than problem solving. Furthermore, planning individualized programs demands more time of both teachers and students, and the final design may not fit into predetermined time slots such as hour-long classes or ten-week quarters. Three months of 1981 were set aside by this internationally renowned educational planner to spend winter quarter as a Regent's professor at the UCLA School of Public Health. Regent's professors are distinguished individuals in nonacademic careers who come to the campus to share their expertise with students and faculty. Dr. Guilbert was one of only two Regent's professors at UCLA this year. Through an eight-week workshop with teachers and students, three public lectures, and individualized consultations, Dr. Guilbert shared principles with UCLA faculty and students which have been endorsed by WHO and taught worldwide. Participants were encouraged to compare their own teaching styles to those supported by the Regent's professor. Dr. Guilbert's own studies in health began in the early 1950s at the Faculte de Medecine in Paris. Then, as a Fulbright Fellow, he completed his internship at the Medical College of Virginia. In 1971, the Frenchman returned to the U.S. and received a Ph.D. in medical education from USC. Just as Dr. Guilbert was completing his internship in 1958, President Charles DeGaulle introduced to France his reforms for medical education. Professor Robert Debre, the father of Prime Minister Michel Debre and a renowned figure among French medical elite, headed the reform committee of medical education. Looking for "young blood," he asked Dr. Guilbert to join his

working group. "It was purely an honorary position, paying $187 a year, but when someone like Dr. Debre asks a nobody like me to join his committee, you say 'yes'," Dr. Guilbert recalls. The first yea:r; Dr. Guilbert sat quietly in the background while the committee designed such "details" as full-time status for clinical professors, the size of cafeterias in university hospitals, and visiting hours of libraries. Then came the question of medical school examinations. The law required that exams should be anonymous and written and scored by the same jury. This was an overwhelming task when the committee realized that within four years there would be 4,000 students in the entering class of the medical school in Paris. To have one jury score 4,000 essay exams, of three to four pages each, sounded impossible. Up went J. J. Guilbert's hand. What about multiple choice tests, a concept to which he had been introduced while studying in the United States. Multiple what? Okay, here's half an office in the Ministry of Education and a parttime secretary and we have to prepare something that will function by 1961, a year and a half hence.

Dr. Guilbert began organizing meetings with deans and professors to design the tests in various disciplines. Finally came the day of reckoning. A trial test was administered in 1960 to 1,800 medical students. No riots took place, no chairs were thrown. The results were ready within two days. Dr. Debre said that was the first good news he had heard since the beginning of the reform. Within a few years, a. central office was handling the tests for Paris and other medical schools, and was capable of grading 24,000 students' examinations per year. Today Dr. Guilbert oversees WHO teacher training programs all over the world. He has personally conducted 72 workshops for more than 2,000 teachers. The workshops are based on the Educational Handbook for Health Personnel, which Dr. Guilbert wrote. Even though it takes time for people to alter their attitudes, Dr. Guilbert is optimistic that changes in education will eventually take place. The fact that there is wide interest among schools, like UCLA, in attending Dr. Guilbert's workshops indicates that the health education profession is ready for self-examination. o f.R.

NEWS New assistant dean appointed Fresh from the frenetic pace in Washington, D.C., and glad to be back in sunny California, Dr. Juel M. Janis is eager to meet the challenges facing the UCLA School of Public Health. She was recently appointed assistant dean for administrative affairs in the School, replacing Edward Nugent. Dr. Janis comes to UCLA with excellent credentials in public health. Most recently (1977-81) she served as the executive assistant to the Surgeon General/ Assistant Secretary for Health in the Department of Health and Human Services in Washington, D.C. She assisted him in his responsibilities as chief health officer and principal advisor to the Secretary on health policy and all health related activities in the Department. Her responsibilities included working with the six agen~ cies of the Public Health Service, other units of the Department, and ~ â&#x20AC;˘---Â Dr. fuel M. Tanis with both public and private professional, academic, and business history at George Washington organizations. In particular, she contributed diUniversity, B.A. (1956). They then moved to Florida where, after havrectly to the disease prevention and health promotion initiatives of ing two children (Laura and Jeff), sh e obtained an M .S. (1966) in the Department, which resulted in psychology from the University of several important health policy Miami. When another move for documents. Dr. Janis was responsiher husband brought them back to ble for developing the health Washington, she completed h er component of the federal day care Ph.D. (1971) in human development regulations and worked on a variety at the University of Maryland. of issues relating to mental health. Since completing her education, She and Dr. Irvin Cushner (who has now also returned to the Dr. Janis served from 1971- 73 as UCLA School of Public Health), coordinator of Head Start in Dade supervised the preparation of a County, Florida, the largest program of its type in the southeastern major report on women and health. She also played an active role in United States. In 1973 she became the work of the Select Panel associate professor and acting for the Promotion of Child Health. chairperson of the Department of Health Sciences at Florida InDr. Janis was born and raised in Los Angeles and was attending ternational University in Miami UCLA when she married. She and (the southern branch of the University of Florida). When h er famher husband, Jay, first lived in Washington, D.C., where she comily moved to Boston in 1976, Dr. Janis became associate professor of pleted her undergraduate work in 18

pediatrics and director of the Behavioral Science Program at the University of Massachusetts Medical School. In 1977 she and her husband moved back to Washington where she served as a social science analyst on the President's Commission on Mental Health, and subsequently as executive assistant to the Surgeon General at the end of that year. Dr. Janis is particularly interested in local, state, and national programs and policies that affect schools of public health. She has already joined Dr. Detels in presenting the Schools' concerns to key legislators in Congress. Assistant Dean Janis is taking a major role in organizing the long-range planning of the School and in identifying ways in which the School can serve the state of California. She will assume the leadership for alumni development and for locating and recruiting alternative sources of funding for the School.

Students placed at top of competition A team of UCLA health service management graduate students proved their financial wizardry when they placed in the top 20 percent in a national health administration competition. In the contest, 29 teams of graduate students were required to manage money matters for a simulated hospital. The UCLA team of M.P.H. students, coordinated by assistant professor Joseph Coyne, Dr.P.H., consisted of Lynda Powell and Douglas Ziegler, second year; and William Caswell and Lori Teslow, first year. They tackled questions relating to hospital rates, investments, and construction projects. The competition was jointly sponsored by the American College of Hospital Administrators and the Western N etwork for Education in Health Administration under the general direction of David Starkweather; Dr.P.H., University of California, Berkeley.

School affiliates with Coastal Region The School now has its own " clinical laboratory" in which students can actually apply their public health education in the community. That laboratory is the Coastal Region of the Los Angeles Department of Health Services. The Department of Health Services is responsible for hospital and public h ealth activities in fiv e ~ ~ ....._______, regions of Los Angeles County. ~ The Coastal Region serves two milg lion people from Malibu to Long b ,_ Beach and inland to Beverly Hills. ~ The implementation of this pro~ 1--~~~~-'-~~~~--~~~~~~~......~~~~~~~~~~~---=::i gram represents the culmination Students discuss career opportunities with prospective employers. of five years of persistent effort by Professor Paul Torrens and others . Career Day "I have been wanting to establish a formal community laboratory so purpose was to bring employers, that students and faculty can be Nearly fifty employers representinvolved in public health research students, and alumni together in a ing all disciplines including hospicommon setting to exchange inon a local level," he says . "The tals, HMO's, international health formation on employment and School of Medicine has a teaching organizations, and county, state, and federal government agencies, career opportunities in public hospital and I believe the School of gathered with students May 1 for a health. At least 450 students Public Health should have someCareer Day. The event was sponvisited the second annual Career thing directly parallel." Day, which is more than double Dr. Torrens developed an affiliasored by the School of Public Health the number wh o atten ded last tion between the UCLA School Placement Office, the Minority of Public Health and the Coastal year. Further indication that the Student's Association, the Public Region through Dr. Ellen Alkon, idea has caught on was that twice Health Student's Association, and as many employers were reprechief physician for public health the SPH Alumni Association, and was held in Ackerman Union. The sented this year than in 1980. and preventive medicine for the Coastal Region. She was recently appointed adjunct professor in public h ealth at UCLA. Nearly 20 students have been working for the region on projects identified by Dr. Alkon. These include setting up new da ta systems, evaluating programs, and preparing surveys for new programs. Dr. Torrens serves as coordinator of the program, and the link between the School and Dr. Alkon.

AT LEFT: Associate Dean La w rence Ash welcomed to UCLA Dr. Ma X u, president of the Peking Medical College. Dr. Ma , a prominent leader of the Chin ese college, met with faculty members h ere to discuss the feasibilit y of an exchange of faculty, research ers, and health professionals between UCLA an d the Peking Medical College. 19

Dean's Council gives School a boost New opportunities are opening up at the School of Public Health, thanks to an 87-member Dean's Council which contributed more than $10,000 to the School in 1980. The alumni and friends who are part of this four-year-young organization each donate $100 or more annually. These unrestricted funds are used at the discretion of the dean for a wide variety of purposes; and can provide "seed" money for research proposals, equipment purchase, student and faculty recruitment and retention efforts, scholarships and fellowships, and a variety of other necessary projects. Dean's Council memberships

are tax-deductible and include library privileges at the UCLA Biomedical Library, information on SPH special events, and social and professional gatherings. Steady growth in membership demonstrates the continuing interest of alumni and friends in promoting the excellence of the School of Public Health. Thanks to all of those whose names are listed here as members of the Dean's Council for 1980. Interested in joining the Dean's Council? Contact Judy Cramer at (213) 825-7325, 405 Hilgard Avenue, Los Angeles, CA 90024.

1980 members Ira R. Alpert Dulcie M. Anderson Dr. Rolando Armijo Dr. Lawrence R. Ash Dr. William A. Benbassat Dr. Warren L. Bennett Mrs. Ann M. Bjorklund Dean Emeritus Lester Breslow Mrs. Helene G. Brown California Pipe Trades Council Dr. Edith M. Carlisle Dr. Virginia A. Clark Dr. Roger A. Clemans Mrs. Anne H. Coulson Dr. William G. Cumberland Dr. Irvin M. Cushner Dr. Climis A. Davos Dean Roger Detels Dr. Brian P. Dolan Olive Jean Dunn Steve Duvall Dr. Robert England Dr. James E. Enstrom Dr. George E. W. Ettima Dr. Paul M. Fleiss Dr. Stefanie Foote Dr. Bruce S. Gillis Mrs. Evelyn M. Goerke Dr. Charles M. Goldstein Dr. Raymond D. Goodman Dr. Donald G. Goodwin Dr. Yolande G. Hamwi Dr. Lucian J. Harris Dr. Carl E. Hopkins Paul S. Jarett Dr. Derrick B. Jelliffe Mrs. Patrice Jelliffe 20

Dr. Arthur I. Johnson Olive G . Johnson Dr. Evelyn M Jones Dr. Wilbert C. Jordan Dr. Snehendu B. Kar Ms. Galia Karapetian Mrs. Frances Keane Dr. Leonard Kleinman Mrs. Carolbeth G. Korn Dr. Joel W. Kovner Dr. Ange J. Lobue John H. Mader Dr. Robert A. Mah Dr. Frank J. Massey Joseph R. McCarthy Lester A. Meis Dr. Marie E. Michnich Dr. Jean L. Mickey Robert D. Montoya Dr. Young Hahn Moon Dr. Charles N . Moss Dr. Alfred K. Neumann Dr. Charlotte Neumann Edward S. Nugent Ms. Ruby S. Okubo Dr. Edward J. O'Neill Mrs. Elizabeth M. Osterkamp Dr. James J. Palmersheim Mrs. Ola Faye Pearson Mrs. Catherine G . Percy Dr. Edward L. Rada Ronald C. Retzer Mrs. Shirley W. Rich Dr. Ruth F. Richards Dr. Stanley N . Rokaw Dr. Martin M. Ross Mrs. Dorothy Rupenian

Dr. Ralph R. Sachs Dr. Jaime G . Salazar Alan Samuels Dr. Marlowe H . Schaffner Mrs. Jamar J. Schoessow Ms. Maria M. Segarra Dr. Marian E. Swendseid Dr. Forest S. Tennant Samuel J. Tibbitts Mrs. Sue Verity Dr. Barbara R. Visscher Dr. Fred W. Wasserman Dr. Graeme A. Williams Alton E. Wilson

ALUMNI Welcome home Spotlight on an alumnus Alumnus Paul Jarett (B.S.P.H. '50) is at home with health care. As founder of National In-Home Health Services, he oversees a statelicensed and Medicare-certified home health agency that serves the extended San Fernando and Santa Clarita Valley areas as well as parts of Los Angeles. Further, his Hospital Home Care Departments, Inc. is a specialized consulting practice which provides guidance and assistance to hospitals nationwide that are interested in developing or expanding their own home care programs. "A massive expansion of home care services has taken place in recent years due to the Medicare program, which now provides care to patients who are homebound and need services only on a parttime or intermittent basis," Jarett points out. Those services include nursing; physical, occupational, and speech therapy; medical and social services; and part-time home health aide assistance. Medical supplies and equipment are also provided. "The earlier home health programs served the long-term needs of chronic patients," Jarett explains. "Although these patients continue to need and receive home care, home health agencies and hospitalbased programs today provide a more sophisticated level of care." Jarett has also incorporated the hospice concept into his services. His "Continuity of Life" program assists patients with terminal illnesses to live out their lives as fully as possible in a caring environment. Patients, with the support and encouragement of family, friends, and an interdisciplinary health care team, participate in the planning and provision of their care. After receiving his bachelor's degree from UCLA in public

health, Jarett earned a master of arts in hospital administration from the University of Iowa. He served in a variety of senior management positions in teaching and community hospitals before establishing, in 1962, his consulting firm of Jarett Associates, Inc. Through the organization, health specialists provide a full range of consultative and direct patient care services to hospitals, qualifying nursing facilities, and other health care organizations throughout Southern California. Jarett is vice president of the UCLA School of Public Health Alumni Association.

Aluntniaskedtolend each other a hand Opening career doors in public health is one way alumni can help each other as well as students in the School. The School of Public Health Placement Office, under the direction of Robert Grossbard, is developing an Alumni Career Resources Program to facilitate this process and to help alumni and students make more informed decisions about future career and job opportunities. The Placement Office will be contacting alumni by mail to find out if they will either participate as Career Day panel speakers, permit students to visit them at work to discuss informally career opportunities in their particular field, or have their employers sponsor public health interns. A file with this information will be maintained by the SPH Placement Office and will be available to all students and alumni. Alumni will be contacted occasionally to share with students and fellow alumni their experiences in various public health fields. For more information about this developing program, call Robert Grossbard at the Placement Office (213) 825-1886.

A capital idea Alumni from the UCLA School of Public Health now living in Washington, D .C., held their first get-together when Dean Roger Detels and Assistant Dean Juel Janis were visiting the nation's capital in March. Approximately forty alumni and their spouses and friends attended this initial meeting. They exchanged information about their activities and offered to keep the School informed about future job opportunities, internships, or research programs in Washington that would be of interest to the students and faculty. Another meeting is being planned for this summer. Anyone interested in finding out more about this group can contact Dr. Janis at the School, (213) 825-5140 or, in the Washington, D .C. area, call Dr. Bryan Luce at (202) 226-2070 or (202) 226-2074.

Harvey Kem, B.S. '64, Environmental and Nutritional Sciences, is administrator of quality assurance for the L.A. County Department of Health Services. He is also a faculty member at California State University, Northridge, and a weekend newsman for KNJO-FM in Thousand Oaks. Ira R. Alpert, M.S.P.H. '66, Hospital Administration, is opening Alpert Enterprises, Inc., a management services firm offering management services for health care professionals, and office services for health care facilities and physicians. The company is located in Los Angeles. Ruth M. Gelber, M.P.H. '67, Gerontology, is the secretary-treasurer of the Affiliated Committees on Aging of Los Angeles County, Inc. She has retired from the L.A. Unified School District and the L.A. County Department of Parks and Recreation, senior citizen's unit. Gary M. Gorlick, M.D., M.P.H. '67, Health Services, is in private practice in pediatric and adolescent medicine in Los Angeles. He also teaches pediatrics and pediatric dermatology at UCLA. Eva J. Damski, M.P.H. '70, Health Services, is a research analyst for the Drug Abuse Programs Office of the Los Angeles County Department of Health Services. Jeff Fields, M.P.H. '70, Health Services, is pharmaceutical consultant for the surveillance and utilization branch of the California Department of Health Services.

NOTES Burton Sokoloff, M.D., B.S. '52, Environmental and Nutritional Sciences, a pediatrician in private practice in Canoga Park, Ca., is chairman of the adoption and dependent care committee of the American Academy of Pediatrics. He has published several articles on counseling adoptive families and on the uniqueness of adoptive families . He has been awarded a grant from the American Academy of Pediatrics for a study on the "Investigation of the Current Status of the Emotional and Physical Health of Indo-Chinese Refugee Children in the United States" and has authored a chapter on adoption and foster care in a new text by Saunders Co., BehavioralDevelopment Pediatrics (in press). Patricia J. Schrom, M.S. '58, Behavioral Science and Health Education, is enjoying retirement and travel. Paul Pearson, M.D., M.P.H. '63, Health Services, is a professor in the Department of Pediatrics at the University of Nebraska Medical Center in Omaha, where he specializes in adolescent medicine. Dr. Pearson is currently president-elect for the American Academy for Cerebral Palsy and Developmental Medicine, and has served on the National Advisory Council on Services and Facilities for the Developmentally Disabled for the Department of Health, Education and Welfare.

Louise C. Remer, M.S. '70, Biostatistics, teaches statistics and computer science part-time at Cal Poly University in Pomona while raising three children ages 2, 6, and 8. Her husband, Don, is director of the Energy Institute and professor of engineering at Harvey Mudd College. Dennis K. Bauer, B.S. '71, M.P.H. '72, Behavioral Science and Health Education, was recently promoted to assistant chief, Inspection and Audit Division, for the Department of Health Services of Los Angeles County. Marc D. Mosar, M.P.H. '71, Population, Family and International Health, is administrator for the Redondo Beach Medical Group, a multi-specialty group practice of thirty-six physicians. David Bradley, M.P.H. '73, Biostatistics, is a statistical consultant for the computer center at California State University, Long Beach. Robin Perley, M.P.H. '73, Behavioral Science and Health Education, is a staff development specialist in continuing education at the Texas Research Institute of Mental Sciences in Houston. Prior to her present position, she was a health educator, first in a high-risk prenatal clinic in Los Angeles, and then at Planned Parenthood in San Diego. Roberta E. (Solomon) Madison, Dr.P.H. '74, Occupational Health, is associate professor in the Health Sciences Department at California State University, Northridge. She is also co-investigator and epidemiologist for a NIOSH-funded grant to investigate lung cancer among steel workers. 21

Valerie Jean Hernandez, M.P.H. '75, Population, Family and International Health, was appointed assistant administrator at Rancho Los Amigos Hospital in Downey, Ca.

Jeffrey Streichler, B.S. '75, Gerontology, is a sanitarian with the Division of Environ· mental Health in the Dade County (Florida) Department of Public Health.

Samuel C. Matheny, M.P.H. '75, Health Services, is director of the Division of Family Medicine and vice-chairman of the De· partment of Family and Preventive Medicine at the USC School of Medicine.

Henry S. Chan, M.P.H. '76, Environmental and Nutritional Sciences, is a captain in the U.S. Army Medical Services Corps.

Deborah Mitzenmacher, M.P.H. '75, Health Services, is a student at the UCLA School of Law. Lucina Siguenza, M.P.H. '75, Population, Family and International Health, is the manager for the family planning program in the Central Region Departm ent of Health Services in Los Angeles County. Marc A. Strassburg, M.P.H. '75, Epidemiology, is an epidemiologist with the Acute Communicable Disease Control Division of the L.A. County Department of Health Services. He is also iri the Dr. P.H. program at UCLA in epidemiology and administration.

Terrence F. Payne, M.P.H. '78, Population, Family and International Health, is the as· sistant director of the newborn nursery at the University of California at Irvine Medical Center. Mary E. Cochran, M.P.H. '79, Maternal and Child H ealth, will graduate from the UCLA School of Medicine in June, 1981 and then will spend three years at a pediatric resi· dency program in Tucson, Ariz.

Gene L. Oppenheim, M.D., M.P.H. '76, Epidemiology, opened a family practice in Santa Monica after completing residency at the University of Washington in Seattle.

Bruce N. Davidson, M.P.H. '79, Population, Family and International Health, is the director of clinical services for La Clinica Familiar de! Barrio in East Los Angeles.

William E. Smith, Pharm.D., M.P.H. '76, Health Services, is assistant administrator and director of pharmacy and central services at Memorial Hospital Medical Center of Long Beach.

Ruth A. Wong, M.P.H. '79, Population, Family and International Health, has been named director of nursing and health services for the Pasadena chapter of the American Red Cross.

David James BigPond, M.P.H. '77, Health Services, is the director of quality assurance, U.S. Public H ealth Service, for the Indian Health Service at Lawton Indian Hospital in Lawton, Okla.

Betty Beliz, M.P.H. '80, Health Education, is the educational coordinator at La Clinica Familiar de! Barrio where her responsibilities include in-service staff training, patient education, outreach presentations, and program developm ent.

Richard A. Goren, B.S. '77, Environmental and Nutritional Sciences, is in his third year of dental school at UCLA.

------------------------------· IIn our alumni we trust I I We want UCLA School of Public Health alumni to believe in the School when we I ask you to invest in its future. We can do this by together shaping the School's I tomorrow.

You've been a part of the School and know what programs best suited your needs, and now, with the benefit of hindsight and insight, you can help us decide in what new directions we should head. You're also active in the public health field and can offer expert advice to our students and faculty and they, in turn, can provide needed services for you. The SPH Alumni Association is more than a support group. It is involved in community public health education. It offers the Lester Breslow Distinguished Lectureship and the UCLA Public Health magazine in addition to activities for faculty, students, and alumni, and financial support of school programs. The SPH Alumni Association now has 150 members, which is a solid foundation for the future. We ask you to join in building on that foundation. Yes, I would like to join the UCLA School of Public Health Alumni Association. NAME _ _ __ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ DIVISION _ _ _ _ _ _ _ _ _ _ _ DEGREE, CLASS YEAR _ _ _ _ __ _ ADDRESS

CITY _ _ _ _ _ _ _ __

STATE Enclosed is my check in support of SPH activities for 1981- 82. D $15 Active Member Contribution: $ _ _ _ __

D $5 Student

D $1 50 Life Member

I'm interested in serving on the SPH Alumni Association Council or Executive Committee. Call me at (Phone) Please publish the following news notes:

I I I I I

Jack Ivie, M.P.H. '80, Health Services, is the assistant executive director of Memorial Hospital of Glendale. Neal Kaufman, M.D., M.P.H. '80, Health Services, is director of the Los Angeles County Coastal Region Child Health De· partment; assistant professor of pediatrics at the UCLA School of Medicine; and a member of the Division of Ambulatory Pediatrics at the Harbor General-UCLA Medical Center. Ann MacArthur Panek, M.P.H. '80, Health Education, is the director of quality assurance and risk management at Delta County Memorial Hospital in Colorado. She repre· sents western Colorado on a statewide risk management committee and is beginning groundwork for Delta's hospital-based h ealth education outreach program. Jean Richardson, Dr. P.H. '80, Behavioral Science and Health Education, is a senior research associate at the USC Comprehensive Cancer Center and USC Laboratory for Health Behavior Studies. Susan A. Uretzky, M.P.H. '80, Population, Family and International Health, is director of business and industry health programs for the Los Angeles County March of Dimes. How about you? We're interested in what's happening in the lives of our alumni. Help us out by sending news about your professional in· volvements, research activities, honors, or personal information for inclusion in UCLA Public Health. Send all relevant information, including degree, class year, and name of your division, to: Barbara Broide c/o Judy Cramer SPH Alumni Association UCLA School of Public Health Los Angeles, Calif. 90024

._ ____________________________ J·- ------------------· Make checks payable to UCLA School of Public Health Alumni Association. Mail to UCLA School of Public Health, Los Angeles, CA 90024.

POTLUCK-Everything was in good taste at the School of Public Health International Dinner April 26, held at the fames E. West Center. The food was "potluck," which added to the flavor of the event. The dinner, sponsored by the SPH Alumni Association, was enjoyed by students, faculty, alumni, and friends .

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